Stage IIIB carcinoma of the cervix in a 19-year-old: a case report

As of December 2009, the American College of Obstetricians and Gynecologists recommends that cervical cancer screening not be initiated until age 21. However, cases, although rare, do exist of advanced cervical cancer diagnosed in women younger than age 21. Our case describes one such rare event and questions whether women should be evaluated based on their individual social behaviors and risk factors.

A 19-year-old, nulliparous, African American female presented to the Methodist Dallas Hospital emergency department with complaints of chronic abdominal and pelvic pain of 3 months' duration which had become acutely more painful 1 week prior to presentation. The patient stated that she had been diagnosed and treated the previous week at a different hospital with pelvic inflammatory disease. On examination the patient was noted to have a large,fungating mass distorting the external surface of her cervix. At that time a Pap smear and a tissue sample biopsy were collected. The patient was admitted with a pelvic mass and was subsequently staged with Stage IIIB cervical cancer.

Our patient demonstrates the importance of evaluating young women at high risk for cervical pathology despite new recommendations from ACOG that cervical cytologic screening begin uniformly at age 21.